Provider Demographics
NPI:1144485608
Name:VILLA MARIA
Entity type:Organization
Organization Name:VILLA MARIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELDINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-277-7999
Mailing Address - Street 1:3102 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6004
Mailing Address - Country:US
Mailing Address - Phone:701-293-7750
Mailing Address - Fax:701-293-5845
Practice Address - Street 1:3102 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6004
Practice Address - Country:US
Practice Address - Phone:701-293-7750
Practice Address - Fax:701-293-5845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1023B314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND033120Medicaid